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fam med 2
USMLE step 2
| Question | Answer |
|---|---|
| Abdominal pain, hypertension, generalized fatigue, and an increase in creatinine within 6 months of renal transplantation are concerning for | acute rejection of the renal allograft. |
| Splenomegaly, jaundice, anemia, elevated mean corpuscular hemoglobin concentration (MCHC), > RDW and characteristic spherocytes on the peripheral smear are indicative of | hereditary spherocytosis. |
| pt presents with abdominal pain, scleral icterus, dark urine, splenomegaly, normocytic anemia, ↑ reticulocyte count, ↑ unconjugated bilirubin, ↑ LDH, ↓ haptoglobin, and hemoglobinuria which started after taking (TMP-SMX). | glucose-6-phosphate dehydrogenase (G6PD) deficiency results in impaired production of NADPH. |
| pt presents with fatigue, pallor, koilonychia, angular cheilitis, decreased hemoglobin, decreased hematocrit, decreased MCV, and increased RDW. | iron deficiency anemia. - calcium and proteins in cow's milk disrupt iron absorption. |
| combination of low MCV, low MCH, high RDW, high TIBC, and low ferritin is | diagnostic of iron deficiency anemia (IDA) |
| Pts with hereditary spherocytosis (HS) who do not receive adequate folic acid supplements are at risk of folic acid deficiency. | present with chronic hemolysis (fatigue, breathlessness, pallor, scleral icterus) and signs of folate deficiency (glossitis, dysphagia, elevated mean red cell volume, low reticulocyte count). |
| side effects of tacrolimus | Nephrotoxic, hyperkalemia, hypertension, glucose intolerance, and neurotoxicity. |
| Cyclosporine is a drug typically used for transplantation rejection prophylaxis | AVR; hypertension, gingival hyperplasia, hirsutism, nephrotoxicity, hyperlipidemia, hyperglycemia, tremor, and an increased risk of malignancies (esp. cutaneous squamous cell carcinomas) and infectious diseases |
| clinical findings (fatigue, fever, and chills) and signs of myelosuppression in laboratory studies (leukocytopenia, thrombocytopenia, anemia) indicate | treatment with methotrexate (MTX). Leucovorin should be administered as prophylactic therapy within 24–48 hours of starting high-dose treatment with MTX. |
| pt's hx of transplant presents with signs of bone marrow suppression, vomiting, diarrhea, hypertension, elevated BUN, and hyperglycemia. | side effects of mycophenolate mofetil, ***Hypercholesterolemia is also common. |
| Ankylosing spondylitis | - TNF-α inhibitors are highly effective in alleviating the symptoms of AS (especially in early disease). - recommended for patients, who do not respond to conventional therapy with NSAIDs and exercise. |
| p's presents with (fatigue, scleral icterus), and recent upper respiratory infection laboratory findings (decreased hemoglobin levels, positive direct Coombs test), decreased haptoglobin | autoimmune hemolytic (intravascular and extravascular anemia) - cold-sensitive IgM antibodies -painless cyanosis in the extremities (acrocyanosis - usually idiopathic - seen in lymphomas, - Mycoplasma pneumonia, - viral disease |
| beta thalassemia, | affects people of Mediterranean descent |
| β-thalassemia minor | A mild version - defect in a single allele of the β-globin gene (heterozygosity). - Typically asymptomatic but can cause mild anemia (microcytic) |
| β-thalassemia major | more severe form - inheritance of two defective alleles in the β-globin gene (homozygosity). - Manifests with hemolytic anemia that typically requires chronic transfusions. |
| Pt with decreased MCV, iron and ferritin are increased, total iron-binding capacity is decreased, | the anemia is likely sideroblastic - microcytic anemia |
| Excessive bleeding in an otherwise healthy young man who easily bruises, with likely family history of the disease in a maternal uncle and isolated PTT elevation, | is highly suspicious for a diagnosis of hemophilia. |
| Porphyria cutanea tarda | defective uroporphyrinogen-III decarboxylase (UROD) - leads to accumulation of uroporphyrinogen in the skin - and chronic photosensitivity with blistering and hyperpigmentation |
| pt with platelet count < 150,000/mm3, epistaxis, petechiae, microangiopathic hemolytic anemia (schistocytes, > LDH, > indirect bilirubin, low hemoglobin), neurologic abnormalities (seizure, confusion), elevated creatinine | thrombotic thrombocytopenic purpura (TTP) - RX; Plasma exchange therapy |
| A regimen of low-dose aspirin and low molecular weight heparin (e.g., such as enoxaparin), | - recommendation for preventing thrombosis and pregnancy-related complications in pregnant women with antiphospholipid syndrome |
| Mutation of coagulation factor V (Factor V Leiden) | does not allow activated protein C, to inhibit the coagulation cascade --> procoagulant state by activation of prothrombin into thrombin (i.e., thrombophilia). |
| Von Willebrand disease - deficiency or defect in von Willebrand factor (vWF). | - hinders ability of platelets to adhere to subendothelial collagen --> platelet inactivation --> prolonged bleeding time. |
| Von Willebrand disease | - PT and PTT are generally normal because the clotting factors are unaffected. ***PTT is low in severe cases from < VIII because factor VIII is bound to vWF in the blood to prevent rapid breakdown |
| Pt with SCD has fevers and bone point tenderness of a bone with an x-ray showing periosteal thickening, elevations and sclerotic changes is particularly concerning for | osteomyelitis. - SCD predisposes to infection with encapsulated bacteria because of the functional asplenia present in most pts by the age of four. - Salmonella is the most common in these pts |
| hydroxyurea | - decreases RBC sickling - increases production of fetal hemoglobin (HbF) --> decrease in relative concentration of hemoglobin S |
| SCD pt presents with altered mental status, fever, increased respiratory rate, low bp, and leukocytosis. with pneumonia (productive cough, inspiratory crackles at left lung base, low oxygen saturation). | most likely has sepsis, - combination of altered mental status, fever, > respiratory rate, low bp, and leukocytosis |
| Sepsis in SCD | PPSV23 prevents the most common cause of sepsis in children with SCD. - infection with Streptococcus pneumonia - 1st dose at 24 months. 2nd dose 3 -5 years later |
| patient’s radiologic findings (subchondral lucency secondary to microfractures, sclerosis, joint space narrowing) are common in | - advanced avascular osteonecrosis. - usually doesn't present with soft tissue swelling - MRI is the diagnosis of choice in early stages. |
| hemophilic arthropathy | caused by Intraarticular iron deposition from hemarthrosis - an important cause of disability in patients with hemophilia. - iron deposition --> increased synovial inflammation and recurrent synovitis --> erosion of cartilage |
| Sudanese boy with hx of dactylitis is jaundiced, has laboratory evidence of hemolytic anemia (increased LDH, indirect bilirubin, decreased haptoglobin), abdominal pain, hypotension, and reticulocytosis which are consistent with a complication of SCD. | - SCD pt with splenic sequestration crisis - U/S splenomegaly - splenomegaly due to pooling of blood in spleen. |
| Inadequate vitamin K | causes deficiencies of vitamin K-dependent clotting factors, including factors II (prothrombin), VII, IX, and X. - increase in PT and PTT seen |
| A transthoracic echocardiogram | - most appropriate next step in managing an asymptomatic patient with a diastolic murmur |
| Right-heart catheterization | - test of choice to confirm the diagnosis of pulmonary hypertension as well as the specific subgroup, |
| pt has watery diarrhea with signs of atypical pneumonia (dyspnea, dry cough, and low-grade fever.) These features together with hyponatremia and an x-ray with bilateral patchy infiltrates suggest | infection with Legionella pneumophila. - confirmed via a positive urine antigen test. |
| RX of Legionella pneumophila. | Levofloxacin |
| atypical pneumonia | Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila. |
| second-line treatments for legionellosis | macrolides such as azithromycin |
| Rapid onset of nausea, abdominal pain, vomiting following the ingestion of coleslaw (presumably containing mayonnaise) is a typical scenario seen in | Staphylococcus aureus -Resolution of symptoms normally occurs within 24–48 hours and antibiotics are unnecessary. |
| Rapid onset of vomiting following the ingestion of a rice dish is a typical scenario seen in? | B. cereus - A gram-positive, spore-forming bacterium - vomiting usually 30 mins-6 hrs after - Produces heat-stable and labile toxins that cause diarrhea and vomiting |
| Amebiasis by Entamoeba histolytica | - fecal-oral route - intestinal manifestations, such as dysentery - extraintestinal manifestations (most often amebic liver abscess) - pain in RUQ |
| patient suffers from watery diarrhea following a recent trip to India. The history is highly suggestive of traveler's diarrhea, which is caused by? | Enterotoxigenic Escherichia coli - watery diarrhea - last 3-4 days - supportive treatment - Antibiotic prophylaxis considered in pregnant woman and immunocompromised. |
| productive cough, hemoptysis, fatigue, and weight loss, history of tuberculosis, and the finding of an intracavitary mass on chest x-ray are suggestive of ? | chronic pulmonary aspergillosis CPA - fungal mass in a pre-existing cavity that mainly affects the lungs and is visible on chest X-ray as a ball that moves on repositioning of the patient |
| Other Forms of CPA | fibrosing and cavitary aspergillosis |
| pt's recent hiking trip, during which time he drank from a stream, lead to greasy and frothy diarrhea. detection of cysts in his stool on microscopy. | giardiasis - impairs absorption - RX; metronidazole - transmitted through contaminated water. |
| pt developed inflammatory diarrhea (bloody stools) 1 day following a food festival, where she ate omelette. microscopy shows stools with PMN | Exudative-inflammatory diarrhea incubation period of Salmonella enteritidis (1–3 days). |
| Oseltamivir | - neuraminidase inhibitor - treat influenza A and B. - Inhibits viral budding and prevents dissemination of the virus into the bloodstream - efficacy within first 24-48 hrs |
| Colonoscopy | screening in pts aged 50–75. - normal-risk individuals, it should be done once every 10 years. - every 5 years in high risk ppl |
| TST is considered positive in HIV-positive individuals | if the induration is ≥ 5 mm |
| An induration of ≥ 10 mm is considered TB-positive | if high risk and children less than 4 |
| an induration of ≥ 15 mm is considered positive for TB. | In the absence of any risk factors |
| latent TB Rx. | - 9 months isoniazid - or 6 months of isoniazid, 4 months of rifampin, or 3 months of isoniazid and rifapentine can be administered. |
| Pseudoappendicitis | seen in - Campylobacter enterocolitis - Yersinia infection. |
| bloody, inflammatory diarrhea | seen in - Campylobacter, - Salmonella, - Shigella, - enterohemorrhagic E. coli, - enteroinvasive E. coli, - Entamoeba Histolytica, - and Yersinia |
| Pt with prior antibiotic use, multiple sexual partners, and yellow green frothy foul smelling vaginal discharge. with an elevated pH value of 5.8 | trichomoniasis. - flagellated protozoa |
| Pt with gray funny smelling vaginal discharge, with elevated pH value of 5.0 and the microscopic finding of clue cells, | bacterial vaginosis. - positive Whiff test/Amine test, Positive if adding 1–2 drops of 10% KOH to vaginal fluid produces fishy smell |
| A pt has multiple risk factors for breast cancer, including nulliparity, late menopause, and hormone replacement therapy. What is the most appropriate next step in a patient with a high risk of breast cancer and suspicious findings on mammography? | an ultrasound-guided core needle biopsy -a nontender, firm, nonmobile breast mass is concerning for breast cancer. |
| pt presents with a tender, firm, swollen, erythematous breast, pain during breastfeeding, fever, and malaise. These symptoms started 2–4 weeks after birth, which suggests? | mastitis. RX; dicloxacillin or cephalexin, |
| Inflammatory breast cancer | advanced invasive carcinoma of the breast. erythematous and edematous (peau d'orange) skin plaques over a rapidly growing breast mass, tenderness, burning, blood-tinged nipple discharge, and axillary lymphadenopathy |
| Paget disease of the breast | A ductal carcinoma (either in situ or invasive) of the secretory ducts - early infiltration of the nipple and areola. - present with a scaly erythematous rash of the nipple and areola. - rash ulcerates & causes blood-tinged nipple discharge. |
| next best step in the management of vagina carcinoma is a ? | - biopsy to confirm the diagnosis, - followed by cystourethroscopy, rectosigmoidoscopy, - pelvic imaging to assess the extent of growth and lymph node spread |
| Dual-energy x-ray absorptiometry | every 10 years for postmenopausal women older than 65 years of age and younger postmenopausal women with high risk |
| Mammography | every 2 years in women between 50–74 years of age to look for suspicious nodules. |
| Pregnant patient with bilateral multinodular ovarian masses and examination findings of virilization are consistent with | luteoma - typically regress spontaneously postpartum - complication is torsion |
| 2 doses of HPV vaccine should be administered | 6 months apart to all individuals 9–14 years of age |
| the CDC recommends vaccination with 3 doses of nine-valent HPV vaccine | all unvaccinated female patients 15–26 years of age, |
| Rectocele | herniation of the front wall of the rectum into the vaginal canal, often due to posterior vaginal wall prolapse. can present with difficulty with bowel movements and a sensation of "fullness" in the vagina. |
| Polycystic ovary syndrome | disrupted LH/FSH balance impairs follicle maturation, LH is higher |
| Obesity is associated with unopposed estrogen stimulation, | which is a risk factor for endometrial hyperplasia. Management; - Endometrial biosy - transvaginal u/s |
| Premenstrual dysphoric disorder | Fluoxetine and other SSRIs are recommended Oral contraceptive also |
| physiologic changes that occur during pregnancy, progesterone indirectly increases minute ventilation by about 40% --> | slightly higher pO2 and a slightly lower pCO2 -->chronic respiratory alkalosis --> compensation by renal acidification. - hemoglobin concentration decreases by about 2 g/dL - increase in GFR --> decrease in creatinine, urea nitogen, uric acid |
| Ultrasonographic measurement of crown-rump length (CRL) | is the single most accurate method of estimating the gestational age in the first trimester (error ± 5–7 days). |
| use of estrogen-containing oral contraceptives increases the risk of | cardiovascular side effects such as hypertension and thromboembolism. - decreased protein S - hyperlipidemia - mild increase in the incidence of hepatic adenomas. |
| Renal artery stenosis | - due to atherosclerosis (most commonly) or fibromuscular dysplasia. - abdominal bruits - signs of hyperaldosteronism (e.g., hypertension and hypokalemia), from activation of the renin-angiotensin-aldosterone system |
| elderly pt shows signs of left ventricular dysfunction (S4 heart sound, rales indicating pulmonary edema, tachycardia) right ventricular dysfunction (peripheral edema, jugular venous distention). NSAIDS likely trigger the acute CHF exacerbation | - consistent with exacerbation of advanced congestive heart failure (CHF). - Pts typically present with symptoms such as exertional dyspnea and orthopnea. |
| Angina with reversible ST-elevations and the negative troponin is typical for | vasospastic angina (Prinzmetal angina). - Calcium channel blockers such as diltiazem are the first-line Rx effective for both acute attacks and prophylaxis |
| pt’s 4-month history of nausea and abdominal discomfort that is exacerbated by large meals and exercise is consistent with atypical chest pain. the pt’s history of smoking, diabetes mellitus, hypertension, obesity, and peripheral arterial disease | perform cardiac stress test |
| Chlorthalidone | A thiazide-like diuretic - inhibits sodium and chloride reabsorption in the loop of Henle. - AVR; hypokalemia, hypercalcemia, hyperglycemia |
| Dressler syndrome | pericarditis that occurs 2–10 weeks after myocardial infarction - immune-complex mediated damage - type 3 hypersensitivity RX; NSAID |
| Dressler syndrome | fever, tachypnea, chest pain that is worse during inspiration relieved by leaning forward a dry cough (due to inflammation of the mediastinal pleura adjoining the pericardium a pericardial rub increased troponin levels diffuse ST elevation |
| patient with signs and symptoms of congestive heart failure (CHF), which can result in increased fluid retention from ADH | An increase in fluid retention is associated with a poor prognosis. |
| Amlodipine | A long-acting dihydropyridine calcium channel blocker - causing peripheral arterial vasodilation. Other side effects; headaches, dizziness, facial flushing, reflex tachycardia. gingival hyperplasia |
| pt started an antihypertensive medication & now presents with peripheral edema. This side effect is due to vasodilation, which increases the hydrostatic pressure within the blood vessels, causing an efflux of plasma into the interstitial space. | Amlodipine is the drug used systemic vasodilator add ARB'S or ACE inhibitors |
| woman did not adhere to medical therapy after the myocardial infarction presents with dyspnea on exertion, a reduced ejection fraction with left ventricular dilation. These findings are most likely the result of unhindered cardiac remodeling. | Rx ; ACE inhibitors - slows down the rate of left ventricular dilation after acute myocardial infarction (MI). - achieved by decreasing preload and afterload due to blockage of angiotensin II. |
| Rx for relief of acute angina | Nitroglycerin - vasodilate by inducing smooth muscle relaxation in both arteries and veins --> Decreased end-diastolic pressure (i.e., preload)--> reduces myocardial wall tension --> decreased o2 demand - venous dilation improves myocardial perfusion |
| pt with signs of congestive heart failure ( progressively worsening exertional dyspnea, nocturia, cold extremities, and edema) The pt had a cerebrovascular accident (TIA 3 years ago). Rx to improve long term survival? | Eplerenone is an aldosterone receptor antagonist |
| Left ventricular ejection fraction | The normal LVEF is >55%. |
| pt has acute left heart failure (paroxysmal nocturnal dyspnea, a cough productive of frothy sputum, a 4th heart sound (S4), and bibasilar crackles ) ABG shows partially compensated primary respiratory alkalosis, likely due to hyperventilation. LEVF 55% | Chronic uncontrolled hypertension -->concentric hypertrophy of myocardium ---> thickened and stiff left ventricle with impaired myocardial relaxation diastolic HF |
| a first-line Rx for symptomatic relief in acute exacerbation of congestive heart failure in patients with normal or elevated blood pressure? | Loop diuretics ** add peripheral vasodilators as adjunct Rx |
| unfractionated heparin or bivalirudin | - patients undergoing percutaneous transluminal coronary angioplasty |
| Rx recommended regimen for all patients after reperfusion therapy | Long-term dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor (e.g., clopidogrel, prasugrel, ticagrelor |
| pt's exertional chest pain and ST-segment depression in v1-v4 during stress testing are consistent with diagnosis of stable angina due to underlying coronary artery disease. | Metoprolol - relieves anginal pain by decreasing heart rate and cardiac contractility, which reduces myocardial oxygen demand. - < cardiac contractility --> improved coronary perfusion by prolonging diastole. |
| An ECG showing regular narrow QRS complexes without P-waves indicates AV nodal reentrant tachycardia (AVNRT), a type of paroxysmal supraventricular tachycardia (PSVT). | Vagal maneuvers |
| the mainstay of therapy for congenital long QT syndrome. | Beta-blockers such as propranolol second line will be -Implantable cardioverter defibrillator |
| Verapamil inhibits cardiac calcium channels and can lead to PR interval prolongation and first-degree AV block, | monitor and follow up with ECG |
| Pt's ECG shows sinus bradycardia. The patient is symptomatic, presenting with hypotension, dizziness, and an episode of syncope (loss of consciousness). | First line; Atropine secondline; Glucagon |
| Polymorphic ventricular tachycardia with cyclic alteration of the QRS axis (sinusoidal waveform) is referred to as torsade de pointes and can progress to life-threatening ventricular fibrillation. | Rx; administering magnesium sulfate. caused by prolonged QT interval |
| Amiodarone | - Pulmonary toxicity (Rx glucocorticoid) - May induce hypothyroidism and/or hyperthyroidism - liver toxicity - arrhythmia - Corneal micro-deposits - Photosensitivity Blue discoloration - peripheral neuropathy |
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beccao
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